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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:55:47 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2022 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20220906172953
FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:RFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 57DATE:
09/14/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Morgan Matthews- AdministratorTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff did not ensure resident's grooming needs were met
Staff did not ensure that resident was adequately fed
Facility does not have a working telephone on the premises
Staff are interfering with resident visits
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen an conducted an unannounced visit to initiate a complaint investigation for the allegations above. LPA Allen met with Morgan Williams who was informed of the purpose of the visit.

First allegation state that staff did not ensure resident's grooming needs were met.
During the investigation the LPA interviews with four (4) staff members, one (1) outside source and observations LPA Allen observed staff members were ensuring that the residents grooming needs are being met. LPA observed residents being cared for during the visit.

Second allegation states that the residents are not adequately fed.
During the investigation LPA Allen interviews and observation, the residents in care are being adequality feed by the staff. During the visit LPA observed a menu for the week and there is sufficient food supplies to met the needs of those in care.
continued......
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20220906172953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ROSE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 366426422
VISIT DATE: 09/14/2022
NARRATIVE
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Third allegation states the facility does not have a working telephone on the premises.
During the investigation and observations, the facility does have a working phone. During LPA’s visit the phone was ringing and staff was available to answer the phone.

Fourth allegation states staff are interfering with resident visits.

During the investigation LPA reviewed documents and interviewed (2) two staff members who stated the procedures for visitors. During the visit LPA observed several visitors coming and going and staff members were following their visiting protocol explained during the investigation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report was discussed and provided to Morgan Williams at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2